Provider Demographics
NPI:1184165649
Name:EDMONDSON, BRANDY (OTR/L)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219B N DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3209
Mailing Address - Country:US
Mailing Address - Phone:606-309-1542
Mailing Address - Fax:
Practice Address - Street 1:215 RICHARDSON WAY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3803
Practice Address - Country:US
Practice Address - Phone:865-992-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist